400 Exam 5 - Part 2 Flashcards
1
Q
roles of the liver
A
carb/glucose metabolism protein metabolism fat metabolism production of bile salts bilirubin metabolism detoxification activates estrogen, testosterone, ADH, aldosterone storage of minerals and vitamins blood reservoir
2
Q
what does the liver detoxify?
A
ammonia (NH3)
3
Q
the liver is Very important in metabolizing certain medications:
A
barbituates
amphetamines
sedatives
4
Q
ϖ Storage of minerals & vitamins
A
A D B12 Iron Copper
5
Q
Patients with liver failure often require vitamin therapy. Which vitamin does the liver require for synthesis of prothrombin?
A
A. Vitamin K
6
Q
o Healthy person rapidly develops severe liver dysfunction marked with the onset of cerebral edema or encephalopathy (swelling of the brain) and/or bleeding due to the inability to clot
A
ϖ Acute—Fulminant Hepatic Failure
7
Q
o Can also have multiple organ failure
o ¾ of these die within days of onset
A
Acute Liver Failure
8
Q
Treatment of acute liver failure
A
liver transplant
9
Q
With acute liver failure they develop massive necrosis of _____.
A
hepatocytes
10
Q
high _____ levels with acute liver failure
A
ammonia
11
Q
risk for ____and ____ with acute liver failure
A
sepsis and shock
12
Q
causes of acute liver failure
A
Heb B infection
tylenol OD
mushroom poisoning
Eclampsia/preeclampsia during pregnancy
13
Q
o What you mostly deal with
o Is progressive, irreversible destruction of the liver function over time
A
Chronic Liver Failure
14
Q
ex of Chronic Liver Failure
A
chrrhosis and Hepatitis C
15
Q
o Hepatitis can cause acute liver failure, but most associated with _____.
A
chronic
16
Q
liver failure is diagnosed by ?
A
several abnormal blood and urine test
17
Q
liver failure is confirmed by?
A
liver biopsy
18
Q
o Removal of a small amount of liver tissue, usually through needle aspiration—permits examination of liver cells
aids in establishing cause of liver disease
A
liver biopsy
19
Q
o Most common indication is to evaluate diffuse disorders of the parenchyma and to diagnose space occupying lesions
A
.
20
Q
_____ and ____ _____ after liver biopsy are the major complications; therefore, coagulation studies are obtained, their values are noted, and abnormal results are treated before liver biopsy is performed
A
o Bleeding and bile peritonitis
21
Q
o Can be performed percutaneously with ultrasound guidance or transvenously through the right internal jugular vein to right hepatic vein under fluoroscopic control – Can also be performed laparoscopically
A
liver biopsy
22
Q
pre op liver biopsy
A
consent
NPO for several hours
Bleeding times and coagulation studies
23
Q
don’t perform needle biopsy if?
A
pt has any bleeding disorders;
24
Q
can be admin for several days before and after if they have bleeding problems
A
Vit K (aqua mephyton)
25
• Patient lies supine and the skin is prepped over the ____ and ___ intercostal space and lidocaine is injected
8th and 9th
26
what to do when they insert the needle
hold breath
27
what to monitor for after liver biopsy?
signs and symptoms of shock and bleeding
28
VS how often ?
every 10-15 min for 1st hour
every 30 min for 1-2 hrs
29
how should patient lye for several hours after?
− Have the patient lie on the right side with a small blanket folded under the costal margin for several hours.
30
− Bed rest for ____ hours or longer
8-10
31
other diagnostic tests for liver failure
Ultrasoundography, CT, MRI
Radioisotope liver scan
Laparoscopy
32
identify normal structures and abnormalities
o Ultrasoundography, CT, MRI
33
assess liver size and hepatic blood flow and obstruction
o Radioisotope liver scan
34
insertion of a fiberoptic endoscope through a small abdominal incision
* Used to examine liver and other pelvic structures
* Used to perform guided liver biopsy, determine cause of ascites, and diagnose and stage tumors of liver and other abdominal organs
o Laparoscopy
35
enlarged
| tender
recent enlargement
36
enlarged
| non-tender
long term enlargement
37
small hard
cirrhosis
38
soft, easily moveable edges
acute hepatitis
39
tender
viral hepatitis
40
non-tender
alcohol hepatitis
41
o More than ___% of the parenchyma of the liver may be damaged before liver function test results become abnormal
70%
42
o Generally measured in terms of serum enzyme activity and serum concentrations of proteins, bilirubin, ammonia, clotting factors, and lipids
o Nature and extent of hepatic dysfunction cannot be determined by these tests alone
liver function tests
43
* Sensitive indicators of injury to the liver cells
| * Useful in detecting acute liver disease such as hepatitis
o Serum aminotransferases (AST, ALT)
44
• AST and ALT are found primarily in the liver and elevate with ____ and ____
liver inflammation and trauma
45
* One of the most frequently used tests of liver damage
* Present in tissues that have high metabolic activity; therefore, the level may be increased if there is damage to or death of tissues of organs such as heart, liver, skeletal muscle, and kidney
AST (Aspirtine)
46
AST (Aspirtine) levels
10-40 units/ml
47
• Not specific to liver disease—level of AST may be increased in what 3 conditions ?
cirrhosis, hepatitis, liver cancer
48
* One of the most frequently used tests of liver damage
* Increase primarily in liver disorders
* Primarily in the liver cells and may be used to monitor the course of hepatitis or cirrhosis or the effects of treatments that may be toxic to the liver
ALT
49
ALT levels
8-40
50
* One of the most frequently used tests of liver damage
* Increased levels are associated with cholestasis but can also be due to alcoholic liver disease
* Kidney has highest level of the enzyme liver is considered the source of normal serum activity
* Determine liver cell dysfunction; Sensitive indicator of cholestasis
* Main value in liver disease is confirming hepatic origin of elevated alkaline phosphatase level
GGT
51
GGT level
0-30 U/L
52
• Our protein to see if person is adequately nourished and see if at risk for F&E imbalance—important
Albumin
53
Albumin levels
3.5-5.5 g/dL
54
Worry about bleeding
may be prolonged in liver disease
• It will not return to normal with vitamin K in severe liver cell damage
Prothrombin time
55
Prothrombin time level
100% or 12-16 seconds
56
• Any time we have liver problems, we worry about the capabilities of the body to properly excrete toxic ____
ammonia
57
ammonia levels
15-45 mcg/dL
58
o Accumulation of fluid in the peritoneal cavity
o Caused by an increase in the portal pressure in the portal circulation that causes an increased hydrostatic pressure
o Liver is not able to produce albumin or protein so there’s a decrease in oncotic pressure to keep the fluid in the vascular space
o Fluid pulled into peritoneal cavity third spacing
ascites
59
sx of ascites
```
hard, firm belly
resp distress (SOB)
increased abd girth and rapid weight gain
striae
hernias
F/E imbalances
hypovolemia
hypokalemic
```
60
removal of fluid from peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions
o
PARACENTESIS
61
•Assess very well before they have this done because you need a baseline you’re pulling a lot of fluid out at one time! (not uncommon to see ___-___ Liters
5-6 Liters)
62
prior to paracentesis
```
consents and witness signature
empty bladder immediately before
assist to upright position
monitor pain and vitals
monitor for hypovolemic shock
```
63
hypovolemic shock sxs:
tachycardia hypotension
64
after procedure
monitor site for leakage
rigidity and pain of abd (peritonitis)
monitor albumin and potassium levels
65
− Often after paracentesis ______ is given by IV to replace from what was drawn out of the body
albumin
66
ϖ Diffuse inflammatory disease of the liver; Ranges greatly in severity
hepatits
67
ϖ Hepatitis Can be caused by several different types of toxins, viruses, disease states
autoimmune
viral
fulminant (Acute Liver Failure)
Hepatitis A-E
68
ϖ Any of these can cause ______________, which is necrotic tissue leading to scarring of liver and could cause chronic liver failure
post-necrotic cirrhosis
69
o However, very uncommon for Hepatitis ____ and ____to progress to chronic liver failure
A and E
70
ϖ Clinical manifestations of Acute viral hepatitis occur in three phases: (not mentioned in book)
preicteric
icteric
posticteric
71
♣ Prodromal time that it can begin, abruptly or gradually
♣ Often symptoms are vague & may be mistaken for the flu joint pain, some fatigue, loss of appetite, nausea, cough
♣ Gradually the liver enzymes, AST, ALT, and bilirubin, start to increase and start to get an increase in viral antibodies
preicteric
72
jaundice phase
| usually a week or so after preicteric phase
icteric
73
recovery phase
lasts several months
labs return to normal gradually
fatigue continues on!!!
posticteric
74
• Not discussing in detail, it’s now being called post transfusion hepatitis; Not a lot of info out there, kind of a mystery
Hepatitis G
75
(often referred to as acute liver failure) is a rapid progression of liver failure which any of these can result in.
o Fulminant
76
Fulminant usually doesn't occur with which two hepatitis?
A and E
77
ϖ Causes diffuse inflammation to the liver with either spotty or single-cell necrosis and liver becomes swollen
ϖ Inflammation and degeneration of the tissue, then we have regeneration so it can heal
Hep A and E
78
Hep A and E are transmitted how
fecal-oral route
79
ϖ Don’t confuse acute hepatitis and acute liver failure .
Acute hepatitis means
they have active symptoms now, doesn’t mean their liver is failing
80
ϖ Transmitted primarily through the Fecal oral route, by ingestion of foods and liquids infected by a virus (RNA virus of Enterovirus family)
Hep A
81
how is Hep A commonly spread
overcrowding
poor sanitation
adult population
spread through water, food, shellfish
82
healthcare workers are not at high risk for Hepatitis ___.
A
83
o People at risk for Hep A
travelers,
daycare workers dealing w/ diapers & stool,
food handlers can contaminate food,
crowded living areas
84
o Most recover from hepA
rarely progresses to ____ or _____ _____ resulting in liver cirrhosis or death
acute liver necrosis or fulminant hepatitis
85
sx of Hep A
```
Anicteric
mild, flu like sxs
low grade fever
severe anorexia
jaundice
dark urine
dyspepsia
indigestion
strong aversion to the taste of cigarettes
```
86
o Symptoms last about ___ months and fatigue can last for quite some time after illness is resolved
(Hep A)
2 months
87
o Jaundice Usually by the time jaundice gets bad with Hep A, all the other symptoms go away—usually around day ___ after symptom onset
10
88
effective and safe vaccine for Hep A
Havrix
| Vagta
89
how is the vaccine given?
18 or older
2nd dose given 6-12 months after the first
90
children or adolescents receive 3 HAV vaccines how:
second dose is given 1 month after first
third dose is given 6-12 months later
91
who is HAV vaccine recommended for?
people traveling to location where sanitation and hygiene are unsatisfactory, for those from high risk group, such as homosexual men, IV or injection drug users, staff of day care centers, and health care personnel
92
♣ Hepatitis A can be prevented by IM admin of globulin during the incubation period, if given w/in ___ weeks of exposure
2 weeks
93
o Liver & spleen are often moderately enlarged for few days after onset; other than jaundice, there are few other physical signs
Hep A
94
o HepA may be in stool for ___-____ days before illness and for __-___ weeks after symptoms appear—stool contagious for quite awhile
7-10
2-3
95
prevention of Hep A
hand washing
proper disposal of sewage
safe water supply
preventable vaccine when traveling
96
ϖ Transmitted by the fecal oral route, principally through contaminated water in areas with poor sanitation
Hep E
97
ϖ Usually due to infected water supply Don’t normally see in the U.S. but in ?????epidemics have been reported
Asia, New Mexico, and Africa
98
Hep E is more prevalent in
pregnant women
99
Hep E in pregnancy can develop too?
fulminant hepatitis
100
no vaccine or prophylactic treatment with ____
Hep E
101
incubation period for Hep E
15-65 days
102
ϖ HDV requires the presence of ____ to be active
HBV
103
HBV is transmitted
blood
104
HBV can cause
acute hepatitis
chronic hepatitis
fulminant
105
high risk for HBV
IV drug users
babies whose mothers are infected
people who have lots of blood transfusions
people with multiple sex partners
106
how is HBV transmitted to baby:
at time of birth and during close contact after
107
ϖ More than 90% of people who contract HBV develop antibodies and can recover spontaneously w/in ____ months if immune system is proper
6
108
sx of HBV
```
arthralgia and rashes
loss of appetite
dyspepsia
abdominal pain
generalized aching
malaise
weakness
may or may not have jaundice
```
109
o Incubation period much longer can have it and not know it for ___-___ months
with HBV
1-6 months
110
prevention of HBV
screening of blood donors
disposable syringes, needles, lancet
good hygiene
wear gloves when handling bodily fluids
111
♣ Active immunization is recommended for people who are high risk for ____-
hepatitis B
112
who else should get HBV vaccine
people with Hep C and other chronic liver disease
113
how is HBV vaccine given
IM in 3 doses:
| the second and third doses are given 1 and 6 months after the first dose
114
o If a person has been exposed but never had disease or immunization – they can receive
HBIG (HB immunoglobulin)
115
o Indicated for people exposed to HBV who never had hepatitis B and have never received hepatitis B vaccine
o Passive immunity
116
o If known exposure they may get this HBIG, should be done promptly within
a few hours or couple days
117
goal for HBV
minimize infectivity and liver inflammation and decrease symptoms
118
if you have Hep D you also have ?
Hep B
119
Hep D is common with:
IV drug users
hemodialysis patients
recipients of multiple drug transfusions
120
ϖ Symptoms same as Hepatitis B however they ???????? compared to HBV
increase in severity
121
ϖ Accounts for nearly half of all new hepatitis cases
| ϖ Screening has significantly reduced number of blood transfusion transmissions
hep C
122
IV drug use is still most common cause of getting ?
Hep C
123
is there a vaccine for C?
NO
124
most common S/E of Hep C
hemolytic anemia
125
nursing care for patient with acute viral hepatitis:
```
adequate hydration
adequate nutrition
managing symtoms
rest
HIGH calorie diet
small freq. meals
avoid ALCOHOL
manage HA without pain meds
control itching
```
126
o Can have increased PT because clotting factors are impaired because this is a function of the liver ---> may be giving ____ __.
Vitamin K
127
o Restrict _____ and ____ if liver function is impaired
protein and sodium
128
pre exposure vaccine for travelers and people at risk; post exposure vaccine if exposed
o Hepatitis A
129
preexposure vaccine recommended for all high risk; post exposure
HBIG w/in hrs-days of exposure + vaccines
o Hepatitis B
130
no vaccine
o Hepatitis C and E
131
requires B to be active
o Hepatitis D
132
is an involuntary tremor or flapping of the hands (also called liver flap) indicator of high ammonia levels and are developing PSE/hepatic coma/encephalopathy; can also be seen in the tongue and in the feet
Asterixis
133
o Patients with all forms of hepatitis should avoid
drinking alcohol and eating raw shellfish
